Revolutionary Worker #1116, August 26, 2001, posted at http://rwor.org
In a run-down group of whitewashed buildings hidden behind the mortuary at Beijing’s You An hospital, Doctor Zhang and a small group of nurses run one of China’s handful of AIDS clinics.
In the summer heat, it is suffocating in the un-air-conditioned clinic that has only six beds. In one small room, a woman sits on a bed, talking to a visitor. She is painfully thin, her arms covered with the tell-tale lesions of AIDS. She says she knows she is dying, but what hurts most is the prejudice of other people.
"If anyone finds out, they won’t dare to come near me. I can’t even tell my friends and relatives. And it’s not just me--if they find out, people will look down on my whole family."
In China--where 1.2 billion people, a fifth of the world’s population live--the HIV virus which gives people AIDS is spreading at an alarming and uncontrollable rate. But Doctor Zhang says, "In the whole of China, there are perhaps only five doctors like me working on HIV."
HIV first came to China during the early 1980s and has been rapidly spreading since 1994. Up until 1989 there were only sporadic reports of AIDS cases. But then from 1989-1994, HIV spread throughout the southern Yunnan Province, where in some communities 30 to 70% of intravenous drug users now have HIV. By 1998, 31 provinces were reporting HIV infections and it was estimated that more than 400,000 people had the HIV virus--and that most did not even know they were infected.
By the end of 2000, statistics released by China’s Ministry of Health showed that the number of people with HIV in the country had increased by 37% from the previous year. And China now ranks fourth among Asian countries in its number of HIV-positive people, following India, Thailand and Burma.
Government officials say there are only 22,500 people who have been registered as HIV positive. Health officials estimate that 600,000 carry the virus. But Chinese doctors who have worked in Henan, where the problem is the most severe, say that more than a million people have probably contracted the AIDS virus from selling blood in this province alone.
The AIDS epidemic has rapidly spread in China for several reasons, including a rise in the number of IV drug users and prostitutes. Today in China, there may be as many as 10 million women working in the sex industry. Yet few people know anything about HIV or how to protect themselves against it.
A huge migrant population is another factor contributing to the spread of HIV. Seventy percent of the people in China live in the rural areas. With the growing gap between the city and countryside, and the rich and poor, tens of millions of migrant workers move regularly between the rural areas and the big cities, looking for work. And this too has facilitated the spread of HIV/AIDS.
China is one of the countries in the world that has the most different strains of the HIV virus--all eight HIV strains are found in China and are spreading. And researchers have found that HIV1 B1 and C strains have recombined in China and that the recombined HIV has also been spreading.
Over the last decade the type of HIV found in China has also changed radically. For example, genetic studies by the Chinese Academy of Preventive Medicine on HIV-virus-infected drug users at China’s southern border with Cambodia showed that the virus frequency changed from 90% European-American B in 1989 to 90% Thailand B by 1996.
In the past, almost 75% of HIV infections in China resulted from intravenous drug use. But in recent years, there has been a dramatic rise in sexually transmitted diseases in China, making the spread of HIV and AIDS even harder to control.
Sexually transmitted diseases (STDs) greatly increase the likelihood of AIDS transmission--for example, people with syphilis are 20 times as likely to be infected by HIV during unprotected sex as are healthy people. Since 1991, STDs have risen at a 20% annual rate in China and experts estimate three million new cases of STDs each year. In some areas, the growth rate of STDs is even higher, like in the rapidly developing southern coastal provinces of Jiangsu where reported STD cases rose at a 60% annual rate during 1990–1994.
Many people don’t have health insurance and can’t afford the cost of getting treated for STDs--about 300 RMB, which is a month’s wages for many people. And most people also cannot afford to pay for an HIV test.
A Problem of Capitalism
Before China was liberated by Mao’s revolution in 1949, the masses of Chinese people suffered bitterly from disease, malnutrition and poverty. There was essentially no medical care, or even basic sanitation, for hundreds of millions of Chinese workers and peasants. Diseases constantly killed large numbers of people. The average life expectancy in 1935 was about 28 years.
When Mao came to power, there were 70 million junkies in China--addicted to opium, morphine and heroin. But the new, socialist society was able to get rid of drug addiction quickly. The drug businesses were busted up, people were organized to struggle with those involved in the sale or use of drugs, and addicts were given medical care and the chance to work. By 1952, there were no more addicts, pushers, or drug smugglers.
The building of a new socialist society also made it possible to provide mass, affordable, and free health care. Huge campaigns were organized to fight disease-carrying insects and improve sanitary conditions in the countryside. In rural coal-mining districts and peasant villages, clinics were set up for the first time.
During the Cultural Revolution, more than a million medical workers were organized to go out into China’s vast, remote countryside to "serve the people."
Almost two million young revolutionaries were trained to become "barefoot doctors"--called this because they lived with the peasants and worked barefoot with them in the fields. They provided basic medical care and health education among the peasants where, in the past, there had been little or no medical facilities.
But in 1976, after Mao Tsetung’s death, his enemies seized power in a coup d’etat headed by Deng Xiaoping. Capitalism was restored and the achievements of socialism, including Mao’s revolution in health care, were reversed. Today, the health care system in China is based on the increasing "privatization" of medicine and the philosophy of "get rich."
The AIDS crisis in China underscores how the restoration of capitalism in China has meant the return of widespread poverty, misery and desperation for millions of people, especially in the countryside. The return of drug addiction, prostitution, and poverty have provided fertile ground for the rampant spread of AIDS. And with China’s government--no longer operating to "serve the people," but instead constantly chasing after higher profits and foreign investments--there is no longer mass, affordable health care or mass health education.
There is widespread ignorance about HIV/AIDS and how it is spread, and so discrimination against people with the disease is common. Surveys show that in rural villages, where AIDS is already a serious problem, only 34% of the people even know about HIV/AIDS. And even in big cities like Beijing and Shanghai, more than 50% of high school students receive no sex education at all. Most medical workers don’t understand how to take care of AIDS patients and don’t want to have contact with them for fear of contagion.
Many government officials in China have delayed or concealed reports on the AIDS epidemic. And local officials have prevented people doing research on the spread of HIV from coming into some areas. One Chinese public health official pointed out that it is hard for the authorities to admit the extent of the AIDS crisis because this would mean acknowledging the widespread problems of prostitution and drug addiction--which basically had disappeared under Mao. Officials are also concerned that admitting the seriousness of the AIDS crisis will hurt tourism, investment, economic development, and the overall social stability of the country.
DONGHU, China -- The most striking things about people from this village are that their threadbare clothes seem way too big and that nearly all of them share a hollow, desperate look in their eyes.
Stooped and shuffling, frail before their time, farmers who should be in their peak productive years are unable to tend their wheat fields or to care for their children. In this picturesque central Chinese village of 4,500, every family is touched by gruesome maladies: fevers, chronic diarrhea, mouth sores, unbearable headaches, weight loss, racking coughs, boils that do not heal.
"Every family has someone who is ill, and many people have two or three," said Zhang Jianzhi, 51, who gathered with others who have the virus here. "I would guess more than 95% of people over the age of 14 or 15 sold their blood at least once," said Ms. Zhang, still stout but suffering from fevers and malaise. "And now we are all sick, with fever, diarrhea, boils."
From an article in the New York Times,
May 28, 2001
In the early 1990s, Chinese biological product companies--some with foreign investors--were looking for a way to get cheap plasma, the part of blood that is used to make medicines like gamma globulin and clotting factors. They looked to China’s vast, impoverished countryside, where desperate peasants would be willing to give blood for money.
Health officials became enthusiastic middlemen, setting up blood collection stations. Some profited personally from the trade. Others saw it as a way to bring cash into a destitute region. The poor villagers--who received about $5 for donating each 400 cc’s of blood, a little under a pint--saw it as a way to buy food and clothing and pay school fees so their kids could get an education.
"There was no need to recruit people -- it seemed like a good opportunity," said Gu Yulan, 46, who now suffers from fevers and mouth sores. "Often the line was so long, it was hard to get a number."
In Xincai, three blood collection stations operated, run by locals but backed as business ventures by government sponsors. One was run for the county hospital. The second was set up by the provincial power supply office. And the third was run by the Chinese Army, which has many business ventures.
In fact, widespread unemployment and poverty have made government-run blood collection centers very popular. People carry plastic passbooks which document their blood-selling history. Each visit has a date, a hemoglobin level, the amount of blood withdrawn, and the payment. It has not been uncommon for some passbooks to have entries about every 10 days. And the plasma collection methods that have routinely been used throughout China have meant that even those who donate blood only a few times run the risk of getting a deadly disease.
In Xincai, blood from dozens of sellers was pooled and put into a huge centrifuge where it was spun to separate the desired plasma. The remaining fraction, mainly red cells, was divided up and transfused back into the sellers. This highly unsanitary process meant that once one blood seller in a village was infected with HIV or hepatitis, others quickly got the disease. And since the sellers were not losing red cells with each donation, which would have resulted in severe anemia, the method also disastrously meant that farmers could sell frequently--raising their chance of infection.
According to the Guangdong provincial health authorities, the greatest part of the 150 tons of blood used clinically in Guangdong Province during 1996 came from people who gave blood for money. Volunteers at a Beijing blood bank were being paid a 200 RMB "nutritional allowance"--about $25, which is a week’s pay for many urban workers.
A Chinese newspaper reported in 1997 that in the Guangdong Province city of Xunde, blood donors were kept in rented hotel rooms by "xietou"--blood pimps. The "donors" paid one-sixth of their payment plus 10 RMB rent per day. To raise productivity, the blood pimp gave the blood donors medicines (up to three times daily) to increase blood volume and disguise disqualifying medical conditions. The blood donors told one journalist that many of them were circulating among blood centers in Guangdong and Fujian provinces in order to give blood more frequently. The donors were giving 400 to 500 ml of blood five or more times each month.
In 1996 there were a series of incidents in Beijing, Henan, and other provinces in which numbers of hospital patients got AIDS from contaminated blood. One incident at a Beijing area hospital involved dozens of people. Lots of blood donors from poor villages traveled from one blood collection station to another. Not only did they pass along infections such as hepatitis as well as HIV to blood recipients but they infected each other as well. Some of these blood donors went to other provinces or regions where payments are higher.
Chronic blood shortages have also given rise to underground, illegal blood collection centers, which are even more unsanitary, dangerous and ruthless.
In 1998 the large province of Henan (with a population of 90 million) had 287 legal blood collection stations and an unknown number of illegal ones. A Chinese epidemiologist estimated that one blood collection station might collect blood as many as 40,000 times per year (counting multiple donations from the same person)--which gives some idea of the enormous potential for spreading HIV infections far and wide in rural China. (See the story of Wenlou village.)
In August 1999, the Henan police intercepted an illegal shipment of 194 bags of blood plasma from paid blood donors on the way to Kaifeng, where it would have been made into blood products. The Henan Red Cross tested the samples and found evidence of hepatitis C virus infection in 17%, syphilis in 44% and hepatitis B virus infection in 100%.
In January 2000, TV news in Beijing reported that professional blood sales pimps had organized migrant workers to pretend that they worked at a factory in Beijing that needed help in meeting its blood donation quota (set by the government). Each donor got 300 RMB (US $37). One woman told a reporter that she got 300 RMB for her blood, as well as a "voluntary blood donor certificate" from her factory. Donors were overheard exchanging blood market price information and the contact phone numbers of blood pimps.
The most active blood pimps were bringing 50 or 60 people at a time to the blood collection station. One blood pimp, a young woman who had brought eight "donors" to the collection center that day, asked a journalist if she had come to give blood. When the journalist replied, "No, I don’t have a Beijing residence permit," the blood pimp said, "No problem! Use mine. We look alike!"
A government raid on one illegal blood collection center revealed the danger and extent of the problem. A backyard, illegal operation in Chengdaopo village in the northwestern part of Lingqiu County was getting ready to transport three tons of blood. When the police smashed down the door of the building, they found some people lying on narrow beds in a dirty, dim lit room. Each person had a tube attached to each arm. Blood was drawn out of one arm and then replaced along with nutrients in the other. Seventeen people were arrested--and the police also confiscated a centrifuge that extracted plasma from blood, 10,400 empty blood plasma bags, 64 1000-ml bags of blood plasma, and other blood collection equipment. All 64 blood plasma bags were positive for hepatitis B and for a HIV screening test. Of the 17 people arrested at the blood collection center, 16 were hepatitis B positive and 11 were HIV positive. Seven of them also had syphilis.
In Henan Province, Liu Hai, Cao Ailing, and her brother Cao Jigang ran a secret blood collection operation in a remote village, using relatives and friends. They divided up tasks--some specialized in recruiting workers, others in sales, storage and transportation, or management. They found professional blood donors from Henan, Shaanxi, Jilin, Hebei and other areas. They divided them into working groups. Blood was drawn from 28 people each day. Two thousand milliliters were taken each time, from which 700 ml of blood plasma was extracted. The remaining red blood cells were transfused back into the donor. The centrifuged blood plasma from different people were mixed in the bags. If there was not enough plasma from one person to fill a plasma bag, the bag would be topped off with blood plasma from another person. The blood donors never had a physical examination. They sold blood five times a week, earning RMB 50 each time.
"I do not know how many villages have a very grave problem, but I know that it’s a lot more than just a handful. I’ve been a doctor for many decades, but I’ve never cried until I saw these villages. Even in villages where there was no blood selling, you now can find cases."
Chinese doctor who works in a province
hit hard by HIV and AIDS
A decade ago, government officials in Wenlou village passed out leaflets calling the practice of blood selling "glorious" and saying "it wouldn’t harm health."
The face of Cheng Jianfei, 38, a former blood seller in Wenlou village, bears the scars of a type of severe herpes infection, common among people with HIV. He says, "Blood selling was something the government encouraged us to do here."
Now, Cheng’s wife and 8-year-old daughter are also infected with the virus.
He spends the equivalent of $125 a month--more than his yearly income--to cover medicines, mostly for fever and diarrhea. He has borrowed money, but is now too poor even to provide food and clothing for his family. Now Cheng worries about who will care for his teenage son when he and his wife die.
This article is posted in English and Spanish on Revolutionary Worker Online
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